Each year over 300,000 people 65 and older are hospitalized for hip fractures, according to the CDC. Listen to Dr. Anthony Florschutz, an orthopedic surgeon with BayCare, discuss different types and treatments of hip fractures and various tips to help prevent a hip fracture.
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Prevention, Treatment and Types of Hip Fractures
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Dr. Florschutz continues to be involved in research and has published articles in the areas of orthopedics and trauma in the United States and internationally. He is a member of the American Medical Association, Orthopaedic Trauma Association, Orthopaedic Research Society, and AO Trauma. Dr. Florschutz’s clinical and research interests include pelvic fractures, acetabular fractures, complex fracture care, nonunion, malunion and infection. He speaks Croatian, Bosnian, Serbian, Czech and Slovak.
Learn more about Dr. Anthony V. Florschutz
Anthony V. Florschutz, MD
Dr. Anthony Florschutz specializes in orthopedic surgery and orthopedic traumatology. He received his Doctor of Medicine from Palacký University in Olomouc, Czech Republic. He completed a general surgery internship and orthopaedic surgery residency at Georgia Regents University in Augusta, Georgia and subsequently subspecialized in orthopaedic traumatology at Orlando Regional Medical Center in Orlando, Florida. He has also trained as a research fellow in biomedical research at the Mayo Clinic in Rochester, Minnesota and received his Doctor of Philosophy in regenerative medicine from Georgia Health Sciences in Augusta, Georgia.Dr. Florschutz continues to be involved in research and has published articles in the areas of orthopedics and trauma in the United States and internationally. He is a member of the American Medical Association, Orthopaedic Trauma Association, Orthopaedic Research Society, and AO Trauma. Dr. Florschutz’s clinical and research interests include pelvic fractures, acetabular fractures, complex fracture care, nonunion, malunion and infection. He speaks Croatian, Bosnian, Serbian, Czech and Slovak.
Learn more about Dr. Anthony V. Florschutz
Transcription:
Prevention, Treatment and Types of Hip Fractures
Amanda Wilde (Host): This is BayCare HealthChat. I'm Amanda Wilde. Hip fractures are serious business and most require medical intervention. Today, we'll look into types of hip fractures, causes, treatment and prevention with Dr. Anthony V. Florschutz, orthopedic surgeon at BayCare. Thank you for stopping by, Dr. Florschutz.
Dr Anthony V Florschutz: Hello, Amanda. Thank you for having me.
Amanda Wilde (Host): Now, how common are hip fractures and who's at risk?
Dr Anthony V Florschutz: So, hip fractures are a common orthopedic injury that we see. There are approximately about a quarter million hip fractures in the United States that occur every year, and we expect by 2050 that this number is expected to double. There are different types of hip fractures, which we'll get into here in a little bit. But about 98% of these hip fractures do occur in patients who are older than 50 years old, and the average age is about 70 to 72 years old when the hip fracture does occur.
Amanda Wilde (Host): So, the risk increases as we age, as the bones may begin to lose density, but it can also happen as a result of trauma. Why can a hip fracture be really a life-changing event?
Dr Anthony V Florschutz: So as a life-changing event, hip fractures can cause increased morbidity and mortality in patients, which basically means that there can be subsequent issues that do occur. They also are an indicator of poor bone health and can also cause decreased ambulation in patients, which can result in other medical issues to occur.
Amanda Wilde (Host): Let's talk about the types of hip fractures. Are some worse than others?
Dr Anthony V Florschutz: There are different types of hip fractures. There are ones that occur through what we call the femoral neck, and those can be treated via a few different modalities. Typically, operative intervention is indicated for those. And then there are other hip fractures that are called intertrochanteric hip fractures, which also do require operative intervention in the vast majority of patients.
Amanda Wilde (Host): Yeah, I was going to ask, what steps do you take with patients after you've diagnosed a hip fracture? What happens next?
Dr Anthony V Florschutz: So standard protocol that is established and becoming a national standard, is that hip fractures need to be addressed within 24 hours, and they need to be treated with operative intervention when possible within 24 hours. We found through looking at many studies that patients who do receive this care have a lower incidence of any subsequent illnesses and complications after breaking their hip and also that we are able to get the patients up and walking much faster.
Amanda Wilde (Host): Why is that?
Dr Anthony V Florschutz: So, the longer a patient is laying in bed, this is just as an example of a potential complication that could occur, if somebody is laying in bed for a longer period of time, they have increased risk for thrombosis in their lower extremities, and also could potentially have problems with their lungs and develop pneumonia.
Amanda Wilde (Host): So, you talked about surgery. Is that the main treatment option for most of the hip fractures that you see?
Dr Anthony V Florschutz: Most hip fractures, I would say 99% of hip fractures do require surgical intervention. The exception would be patients who are under hospice care and do not desire to proceed with surgical intervention. Otherwise, the main intervention for a hip fracture is operative intervention.
Amanda Wilde (Host): So, for those who do get surgery, what are the expectations a patient should have during treatment? And what are the short and sort of long-term results that we should keep in mind?
Dr Anthony V Florschutz: So, short term, when the patient presents and is diagnosed with a hip fracture, they should expect, in general, a workup by both the medicine team and the orthopedic team. And if there's any sort of optimization for any coexisting conditions that would be performed expeditiously at that time.
Subsequently, we'll proceed with going to the operating room. The operative interventions typically take about an hour in time, an hour, sometimes even less than an hour. The patient wakes up. The majority of our fixation techniques that nowadays are good enough and are successful enough that we are able to allow the patients to walk immediately after the surgery.
Right after the surgery, there is significant decrease in the pain that is being caused by the hip fracture, although there is some pain also that does occur with where the incisions were made and depending on what procedure was done. But the goal is to have the patient up and walking by the next morning.
Amanda Wilde (Host): It's amazing, and that's also an amazingly short surgery time.
Dr Anthony V Florschutz: Yes, the surgery times do vary, but I believe that most of the surgeries, at least in my hands, take one hour or less for the management.
Amanda Wilde (Host): And when you say people are walking so soon, within 24 hours after the surgery, is there further rehabilitation in store after the surgical repair?
Dr Anthony V Florschutz: Yes, there's typically physical therapy that follows the intervention or after surgical repair. This usually carries on in the outpatient setting. We look very much at how the patient was walking prior to the fracture, so if they were using a cane or not using a cane or using a walker. And the goal is to try to get them back to that baseline. Sometimes, with older individuals, it's difficult to get them back to the baseline. And we know probably in about 10 to 20%, the new baseline, there is increased need for an assistive device. So for instance, if somebody was not using a cane, they may need to use a cane after the surgery, or if they were using a cane, they may need to transition to a walker as more of a baseline ambulatory status. But it is not uncommon that patients get back to their full ambulatory status after fixation of the hip fracture.
Amanda Wilde (Host): And it sounds like improved techniques bring improved outcomes as well.
Dr Anthony V Florschutz: Yes, that is very true.
Amanda Wilde (Host): Now that we've talked about everything that we can do after a hip fracture, what can we do, if anything, to prevent getting one in the first place? Are there steps we can take in terms of prevention?
Dr Anthony V Florschutz: So, I think in general, good bone health is very important and this is something that can be addressed from primary care physicians and treatments can be initiated at that time. And some are as simple as daily exercise, such as walking on a daily basis, and making sure that the bone is being stimulated to stay strong. A healthy diet and there are also supplements that can be taken. And then, there's medications in the more extreme cases that can be taken in order to prevent bone loss and, in some cases, even regenerate bone.
Amanda Wilde (Host): Oh really? Bone can be regenerated?
Dr Anthony V Florschutz: There are certain new medications that are out there that actually grow bones, so to speak.
Amanda Wilde (Host): So really, the key is talking to your primary care physician about what you can do to keep your bones healthy. But also, if you do get a fracture, prompt surgical repair and rehabilitation are the important parts of recovery.
Dr Anthony V Florschutz: Yes. And I think initially prior to any sort of hip fracture, it is a question that should be asked, as people get older, if they can ask their primary care physician if there's anything they can do to improve their bone health. And what are the options for that. After a hip fracture and identification of poor bone health, it would be very beneficial to continue working on bone care through the primary care physician and orthopedic surgeon, and have discussions with them in regards to how bone health can be optimized.
Amanda Wilde (Host): Excellent. Dr. Florschutz, thank you for all the important information on bone health after a hip fracture, and what we can do for both recovery and prevention. It's good to speak with you today.
Dr Anthony V Florschutz: Thank you very much.
Amanda Wilde (Host): And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. For more health tips and updates, follow us on your social channels. Always remember to subscribe, rate, and review this podcast and all other BayCare podcasts, so we can share the wealth of information from our experts. I'm Amanda Wilde. Until next time, be well.
Prevention, Treatment and Types of Hip Fractures
Amanda Wilde (Host): This is BayCare HealthChat. I'm Amanda Wilde. Hip fractures are serious business and most require medical intervention. Today, we'll look into types of hip fractures, causes, treatment and prevention with Dr. Anthony V. Florschutz, orthopedic surgeon at BayCare. Thank you for stopping by, Dr. Florschutz.
Dr Anthony V Florschutz: Hello, Amanda. Thank you for having me.
Amanda Wilde (Host): Now, how common are hip fractures and who's at risk?
Dr Anthony V Florschutz: So, hip fractures are a common orthopedic injury that we see. There are approximately about a quarter million hip fractures in the United States that occur every year, and we expect by 2050 that this number is expected to double. There are different types of hip fractures, which we'll get into here in a little bit. But about 98% of these hip fractures do occur in patients who are older than 50 years old, and the average age is about 70 to 72 years old when the hip fracture does occur.
Amanda Wilde (Host): So, the risk increases as we age, as the bones may begin to lose density, but it can also happen as a result of trauma. Why can a hip fracture be really a life-changing event?
Dr Anthony V Florschutz: So as a life-changing event, hip fractures can cause increased morbidity and mortality in patients, which basically means that there can be subsequent issues that do occur. They also are an indicator of poor bone health and can also cause decreased ambulation in patients, which can result in other medical issues to occur.
Amanda Wilde (Host): Let's talk about the types of hip fractures. Are some worse than others?
Dr Anthony V Florschutz: There are different types of hip fractures. There are ones that occur through what we call the femoral neck, and those can be treated via a few different modalities. Typically, operative intervention is indicated for those. And then there are other hip fractures that are called intertrochanteric hip fractures, which also do require operative intervention in the vast majority of patients.
Amanda Wilde (Host): Yeah, I was going to ask, what steps do you take with patients after you've diagnosed a hip fracture? What happens next?
Dr Anthony V Florschutz: So standard protocol that is established and becoming a national standard, is that hip fractures need to be addressed within 24 hours, and they need to be treated with operative intervention when possible within 24 hours. We found through looking at many studies that patients who do receive this care have a lower incidence of any subsequent illnesses and complications after breaking their hip and also that we are able to get the patients up and walking much faster.
Amanda Wilde (Host): Why is that?
Dr Anthony V Florschutz: So, the longer a patient is laying in bed, this is just as an example of a potential complication that could occur, if somebody is laying in bed for a longer period of time, they have increased risk for thrombosis in their lower extremities, and also could potentially have problems with their lungs and develop pneumonia.
Amanda Wilde (Host): So, you talked about surgery. Is that the main treatment option for most of the hip fractures that you see?
Dr Anthony V Florschutz: Most hip fractures, I would say 99% of hip fractures do require surgical intervention. The exception would be patients who are under hospice care and do not desire to proceed with surgical intervention. Otherwise, the main intervention for a hip fracture is operative intervention.
Amanda Wilde (Host): So, for those who do get surgery, what are the expectations a patient should have during treatment? And what are the short and sort of long-term results that we should keep in mind?
Dr Anthony V Florschutz: So, short term, when the patient presents and is diagnosed with a hip fracture, they should expect, in general, a workup by both the medicine team and the orthopedic team. And if there's any sort of optimization for any coexisting conditions that would be performed expeditiously at that time.
Subsequently, we'll proceed with going to the operating room. The operative interventions typically take about an hour in time, an hour, sometimes even less than an hour. The patient wakes up. The majority of our fixation techniques that nowadays are good enough and are successful enough that we are able to allow the patients to walk immediately after the surgery.
Right after the surgery, there is significant decrease in the pain that is being caused by the hip fracture, although there is some pain also that does occur with where the incisions were made and depending on what procedure was done. But the goal is to have the patient up and walking by the next morning.
Amanda Wilde (Host): It's amazing, and that's also an amazingly short surgery time.
Dr Anthony V Florschutz: Yes, the surgery times do vary, but I believe that most of the surgeries, at least in my hands, take one hour or less for the management.
Amanda Wilde (Host): And when you say people are walking so soon, within 24 hours after the surgery, is there further rehabilitation in store after the surgical repair?
Dr Anthony V Florschutz: Yes, there's typically physical therapy that follows the intervention or after surgical repair. This usually carries on in the outpatient setting. We look very much at how the patient was walking prior to the fracture, so if they were using a cane or not using a cane or using a walker. And the goal is to try to get them back to that baseline. Sometimes, with older individuals, it's difficult to get them back to the baseline. And we know probably in about 10 to 20%, the new baseline, there is increased need for an assistive device. So for instance, if somebody was not using a cane, they may need to use a cane after the surgery, or if they were using a cane, they may need to transition to a walker as more of a baseline ambulatory status. But it is not uncommon that patients get back to their full ambulatory status after fixation of the hip fracture.
Amanda Wilde (Host): And it sounds like improved techniques bring improved outcomes as well.
Dr Anthony V Florschutz: Yes, that is very true.
Amanda Wilde (Host): Now that we've talked about everything that we can do after a hip fracture, what can we do, if anything, to prevent getting one in the first place? Are there steps we can take in terms of prevention?
Dr Anthony V Florschutz: So, I think in general, good bone health is very important and this is something that can be addressed from primary care physicians and treatments can be initiated at that time. And some are as simple as daily exercise, such as walking on a daily basis, and making sure that the bone is being stimulated to stay strong. A healthy diet and there are also supplements that can be taken. And then, there's medications in the more extreme cases that can be taken in order to prevent bone loss and, in some cases, even regenerate bone.
Amanda Wilde (Host): Oh really? Bone can be regenerated?
Dr Anthony V Florschutz: There are certain new medications that are out there that actually grow bones, so to speak.
Amanda Wilde (Host): So really, the key is talking to your primary care physician about what you can do to keep your bones healthy. But also, if you do get a fracture, prompt surgical repair and rehabilitation are the important parts of recovery.
Dr Anthony V Florschutz: Yes. And I think initially prior to any sort of hip fracture, it is a question that should be asked, as people get older, if they can ask their primary care physician if there's anything they can do to improve their bone health. And what are the options for that. After a hip fracture and identification of poor bone health, it would be very beneficial to continue working on bone care through the primary care physician and orthopedic surgeon, and have discussions with them in regards to how bone health can be optimized.
Amanda Wilde (Host): Excellent. Dr. Florschutz, thank you for all the important information on bone health after a hip fracture, and what we can do for both recovery and prevention. It's good to speak with you today.
Dr Anthony V Florschutz: Thank you very much.
Amanda Wilde (Host): And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. For more health tips and updates, follow us on your social channels. Always remember to subscribe, rate, and review this podcast and all other BayCare podcasts, so we can share the wealth of information from our experts. I'm Amanda Wilde. Until next time, be well.